Chapter 4 - Dementia Flashcards
What is dementia?
A progressive clinical syndrome characterised by a range of cognitive and behavioural changes
What are the main types of dementia?
Alzheimer’s Disease
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia
What is early onset dementia?
Dementia that occurs before 65 years
What usually causes vascular dementia?
Cardiovascular disease, which causes a reduced blood supply to the brain
What condition is Dementia with Lewy Bodies often associated with?
Parkinson’s Disease
How is dementia usually diagnosed?
Based on symptoms and a clinical assessment tool
What are the symptoms of dementia?
Cognitive symptoms
Memory problems
Disorientation
Difficulty carrying out daily tasks
Behavioural problems Aggression Agitation Depression/anxiety Sleep disorders Psychosis
Which dementia has a stepwise pattern with regards to the severity of symptoms?
Vascular dementia
What additional symptoms may be seen with Dementia with Lewy Bodies that aren’t seen in other types of dementia?
Parkinsonian motor features
E.g. Bradycardia, shuffling gait, rigidity
What medications can cause cognitive decline?
Anticholinergics e.g. TCAs Anticonvulsants e.g. phenytoin, phenobarbital Antipsychotics e.g. haloperidol Analgesics e.g. NSAIDs, opioids Benzodiazepines Corticosteroids
What is an example of an assessment tool for dementia?
MMSE
What are the 5 principles of the mental capacity act 2005
Assume capacity Maximise decision making capacity Freedom to make seemingly unwise decisions Best interests of the patient Least invasive option
What is a power of lasting attorney?
A document where a person can nominate someone else to make certain decisions on their behalf when they are unable to do so themselves
What is advanced decision making?
Allows for people who understand the implications of their decisions to state their treatment wishes in advance
Where should treatments for the cognitive symptoms of dementia be initiated?
When can they be issued in primary care?
Secondary care by a specialist
They can then be continued in primary care under a shared care agreement
What is anticholinergic burden and what are the effects of this?
The cumulative effect of taking one or more medications with a high anticholinergic activity
Effects include increased risk of falls, delerium, cognitive decline and possibly dementia
What are some examples of drugs that significantly increase the anticholinergic burden?
Amitriptyline
Antihistamines e.g. chlorphenamine
Antipsychotics e.g. olanzapine, quetiapine
Urinary antispasmodics e.g. solifenacin, tolteridone, oxybutynin
Hyoscine
What drugs are used for the cognitive symptoms associated with dementia, and for which type of dementia are they licensed in?
Donepezil
Rivastigmine
Galantamine
Memantine
Licensed in Alzheimer’s, but also used in some other types of dementia, e.g. dementia with Lewy Bodies
What are some side effects associated with donepezil, rivastigmine, galantamine and memantine?
Nausea, dizziness, headache, muscle stiffness, tremor, bradycardia, hypotension (may increase the risk of falls)
What is the relationship between acetylcholine and dementia?
Ach is the chemical transmitter for the brain cells that run the memory system
In dementia, the production of Ach in the neurones is reduced
What drugs are used in mild Alzheimer’s Disease?
AchE Inhibitors
What drugs are used in moderate Alzheimer’s Disease?
First line - AchE Inhibitors
If these are not effective, add on memantine
If these are contraindicated use memantine alone
What drugs are used in severe Alzheimer’s Disease?
First line - memantine
What can happen if you discontinue AchE Inhibitors?
Worsening cognitive function
